About Acid Reflux (Heartburn) in Children
Acid reflux in children, also known as gastroesophageal reflux (GER), is a condition where the contents of the stomach flow back into the esophagus—a muscular tube that connects your throat to your stomach—causing irritation and discomfort.
It’s common for children and babies to have occasional acid reflux or heartburn. But if acid reflux lasts a long time, it may be a sign of gastroesophageal reflux disease (GERD). Symptoms can be mild or severe; some children may not notice them, while others may find that the symptoms affect daily life. In infants under a year old, acid reflux can cause spitting up. GERD is a longer-term condition that causes more serious symptoms and can lead to complications.
Treatment for GERD may involve lifestyle changes, medications, or surgery to ease symptoms and prevent further issues. A doctor might suggest more tests to find the cause of GERD in children.
The disease causes of acid reflux in children include:
- Structural and functional differences: In children, the esophagus is shorter, and the muscles at the top and bottom of the esophagus (called sphincters) are not fully developed. Also, the angle where the esophagus meets the stomach isn’t as sharp. These factors can make acid reflux more likely.
- Lying down position: Infants and young children spend most of their day in a lying down position, which can lead to more acid reflux.
- Diet: The milk-based diet of infants and young children can also contribute to acid reflux.
The non-modifiable risk factors of acid reflux in children cannot be changed or controlled to lower the chances of getting acid reflux. These include:
- Premature birth: Babies born early have a higher chance of developing acid reflux because their digestive system may not be fully developed.
- Neurologic conditions: Children with certain brain or nerve conditions may have more difficulty controlling the muscles involved in swallowing, leading to a higher risk of acid reflux.
- Repaired esophageal atresia: Babies born with an esophagus that isn’t connected to the stomach need surgery to correct it, but even after repair, they have a higher chance of acid reflux.
- Esophageal achalasia: When the muscles in the esophagus don’t work properly, it can make swallowing difficult, which can lead to acid reflux.
- Hiatal Hernia: This condition happens when part of the stomach pushes up into the chest through the diaphragm, making acid reflux more likely.
The modifiable risk factors of acid reflux in children can be influenced or changed. These include:
- Obesity: Excess body weight can increase pressure on the stomach, which may lead to acid reflux.
- Chronic respiratory disorders: Long-term breathing issues, like asthma, can increase pressure in the abdomen and make acid reflux more likely.
It's important to note that while these risk factors have been identified, not all children with these risk factors will develop acid reflux. Additionally, there may be other factors that contribute to acid reflux in children that are not yet fully understood. If you suspect your child may be experiencing acid reflux, it's best to consult with a healthcare professional for an accurate diagnosis and appropriate management strategies.
The most common early symptoms of acid reflux in children include:
- Heartburn or a painful burning sensation in the center of the chest
- Regurgitation, where stomach contents travel back upward into the esophagus or throat
- Nausea and vomiting
- Chest or abdominal pain
- Cough
- Hoarseness or wheezing
- Pain with swallowing
As acid reflux progresses or becomes more severe in children, additional symptoms may occur, such as:
- Refusal to eat and difficulty eating or swallowing
- Irritability during feeding
- Wet burps or hiccups
- Failure to gain weight
- Abnormal arching of the back
- Frequent coughing or recurrent pneumonia
- Gagging or choking
- Chest pain or heartburn
- Disturbed sleep
It's important to note that not all children with acid reflux will experience all of these symptoms. If you suspect your child may have acid reflux, it's best to consult with a healthcare professional for an accurate diagnosis and appropriate management.
To diagnose acid reflux in children, doctors commonly perform the following examinations, tests, and procedures:
- Review of symptoms and medical history: The doctor will evaluate your child's symptoms and medical history to assess the possibility of acid reflux.
- Upper GI series: This test involves your child drinking a contrast liquid called barium while X-rays are taken to examine the shape of the upper gastrointestinal tract.
- Esophageal pH and impedance monitoring: A thin flexible tube is inserted through your child's nose into the stomach to measure the amount of acid or liquid in the esophagus.
If the initial tests do not provide a definitive diagnosis or if further evaluation is needed to determine the stage or severity of acid reflux, additional examinations, tests, and procedures may be performed:
- Biopsy: During an upper GI endoscopy, a doctor may take a tissue sample (biopsy) from the esophagus or stomach to examine any issues more closely.
- 24-hour pH Monitoring: This test uses a thin tube placed in the esophagus for a full day to track acid levels, providing detailed information on acid patterns over time.
- Bravo wireless esophageal pH monitoring: A small capsule is placed in the esophagus during an endoscopy, which measures acid levels and sends data wirelessly to a receiver worn by the patient. This allows extended monitoring wirelessly without a nasal tube.
- Esophageal Manometry: This test measures muscle movements in the esophagus to check for any issues that might lead to acid reflux.
It's important to consult with your child's healthcare professional regarding which tests are appropriate for their individual situation.
The goals of treatment for acid reflux in children are to relieve symptoms, reduce inflammation, and prevent complications. Here are the most common treatment options:
Medication Types:
- Antacids: Help neutralize stomach acid
- Proton pump inhibitors (PPIs): Reduce acid production in the stomach
- H2 blockers: Block the release of stomach acid
- Neuromodulators are medications that change how nerves send signals in the body. Medications like selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and GABA analogs can help manage symptoms that don’t improve with acid-suppressing treatments or aren’t directly caused by acid reflux.
Medical Procedures:
- Endoscopy: Allows doctors to visualize and treat any problems in the esophagus.
- Fundoplication: Surgical procedure where the upper part of the stomach is wrapped around the lower esophagus to strengthen the esophageal sphincter.
Lifestyle Changes:
- Feeding techniques: Burping infants during feeding, keeping them upright for 30 minutes after feeding, and offering smaller, more frequent meals.
- Avoiding trigger foods: Not feeding children foods that can trigger acid reflux.
- Lifestyle adjustments: Elevating the head during sleep, quitting smoking so children are not exposed to second hand tobacco smoke, and maintaining a moderate weight.
Remember to consult with a healthcare professional before starting any medication or treatment plan. The specific approach may vary based on individual circumstances.
Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.